Provider Demographics
NPI:1841771987
Name:GOODENOUGH, SAMANTHA SCALA (OD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:SCALA
Last Name:GOODENOUGH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3272 30TH ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-2920
Mailing Address - Country:US
Mailing Address - Phone:607-242-1904
Mailing Address - Fax:
Practice Address - Street 1:819 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-1405
Practice Address - Country:US
Practice Address - Phone:646-517-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008820-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist